Gliederung

Objective

Our study retrospectively evaluated the efficacy of the horizontal muscle surgery and the Hummelsheim transposition procedure with or without augmentation in a long term follow-up.

Methods

Authors evaluated a long-term outcomes of these two surgical methods for the treatment of six nerve palsy.Ninety seven patients with paralytic strabismus secondary to sixth nerve palsy undergone surgery in the period from January 1990 to January 2004. Group A included 46 patients, who were treated using a large recession of the medial rectus combined with a supramaximal resection of the lateral rectus. Group B comprised 51 patients in whom were performed the Hummelsheim transposition procedure with or without resection of transposed half-tendon vertical muscles, always combined with recession of medial rectus. The modified split-tendon Hummelsheim procedure involves half-tendon transpositions of the adjacent rectus muscles to the insertion of the paralyzed muscle, coupled with resection of the transposed halves. The mean follow-up was 76.6 months (range, 3 to 165 months). The primary position deviation and the occurence of diplopia after one surgical procedures were compared in the both groups preoperatively and postoperatively. For statistical analysis was used the Student-t test.

Results

The mean preoperative primary position deviation in the Group A and B was 52 prism diopters (PD),(range: 25 to 76 PD), and 58 PD (range: 30 to 90 PD), respectively. Diplopia was present in 81% of the Group A patients, and 89% of the Group B patients. At last visit postoperatively, the mean primary deviation decreased to 24 PD (range: 2 to 36 PD) in A group, and 6 PD (range: -8 to 20 PD), (P= 0.03). Diplopia in primary position postoperatively was present in 28 % of A group, and 7% of B group (P= 0.0295). No cases of anterior segment ischemia or induced vertical deviation were found.

Conclusions

The use of the augmented half-tendon transposition procedure resulted in a significantly better primary position of eyes without diplopia postoperatively, than only the graded recession-resection procedure of the horizontal muscles. The modified Hummelsheim procedure with augmentation achieved by resection of the transposed halves is capable to correct a very large angles of deviation associated with abducens palsy of various etiologies.